Disaster and Diarrhea

Another week … another disaster involving tourists. This tragic incident involved a Bhudda Air flight from Kathmandu over Everest, which crashed on its return to Kathmandu. Sixteen people were killed. Again the thought “Gee, that could have happened to me.” I took that same flight in 2001 with my son Benjamin. The weather was perfectly clear for our flight, and Benny and I were the lone North Americans amongst a planeful of Japanese tourists. When we deplaned after seeing Everest, we were presented with our official certificate. Four months after our return home, the royal family in Nepal was massacred. Tourism to this beautiful country, according to the travellers I see in my office, has still not recovered. This tragedy will certainly make people think twice about taking the once in a lifetime flight over Everest. Here you see our brief view of the world’s tallest mountain.

On a nearby note, it seems this is the ideal time to visit India. The monsoons are over, and the bugs and the infections they transmit have disappeared … or have they. Dengue fever and chikungunya virus are two mosquito-borne infections that are probably most prevalent in the summer monsoon months, especially in the south. But they do get up to more northern parts of India. The question becomes … when does the risk disappear?

Malaria, a more serious mosquito-borne infection, occurs throughout India. However it is probably less of a problem in urban areas, further north, or in their “winter”. I recall landing in New Delhi many years ago in January to the sight of people wearing shawls and scarves and sitting around fires. Being Canadian, I only wore a T-shirt. But there were really no mosquitoes. I believe that the recommendation stemming from European travel medicine experts is not to prescribe antimalarials to travellers to India, as the risk is low. Insect precautions are encouraged, and of course people are advised to seek medical attention should they develop a fever. In North America, we tend to have a “zero tolerance” attitude towards antimalarials and India. We/I recommend them, though as the cooler weather approaches and many of my patients only go to Rajasthan, I tell them the risk is quite low.

If I were to rank all of the world’s countries according to their risk of traveller’s diarrhea, India would be at the top, perhaps tied with Egypt and Cameroun! All of the Dukoral in the world doesn’t seem to be able to stop the inevitable. Neither does the usual “Boil it, bottle it, peel it, cook it …. or forget it“. Part of the reason the latter phrase doesn’t do it, is that people don’t do it! Their hotels are five star and not inexpensive. Hence they think the food is safe, regardless of how it has been prepared, stored or handled.

The usual treatment of traveller’s diarrhea, or Delhi Belly as it is affectionately known as there, is clear fluids, perhaps a shot of Imodium or PeptoBismol, and when necessary, an antibiotic such as Cipro or Zithromax. One of the bacteria responsible for TD is Campylobacter, and it is becoming increasingly resistant to Cipro, especially in Thailand and Vietnam, but also India and Nepal. The $64,000 question (does anyone still remember that program) is when is that antibiotic necessary. The obvious answers are when you are very ill with fever and chills, if there is blood or mucous in your stools (dysentery), when your trips to the john are very frequent, or when you aren’t getting better in a day or two with steps one and two.

Other options for using an antibiotic a bit more promptly include, but are not limited to: I have no toilet paper, I can’t get up from a squat, this bus has no toilet, the train has one but I don’t want to use it, and last but not least, I just want to feel better more quickly! I tend to be an early user of antibiotics – even just for a day – when my bowels go wonky in a hot climate. I realize that others are more concerned about the adverse effects of such drugs than I am. To each their own.